Antibiotic cement-coated intramedullary nail is cost-effective for the initial treatment of GAⅢ open tibia fractures

ObjectiveTo evaluate the cost-effectiveness of antibiotic cement-coated intramedullary nails (IMN) in the initial management of Gustilo-Anderson type Ⅲ (GAIII) open tibia fractures.MethodsA break-even equation was used to analyze the costs associated with antibiotic cement-coated IMN and postoperative infection following GAⅢ open tibia fractures. This equation produced a new infection rate, which defines what percentage the antibiotic coated IMN needs to decrease the initial infection rate for its prophylactic use to be cost-effective. The postoperative infection rate used for calculations was 30%, a value established in current literature for these fracture types (6–33%). The institutional costs associated with a single operative debridement and resultant inpatient stay and treatment were determined. A sensitivity analysis was conducted to demonstrate how various total costs of infection and different infection rates affected the break-even rate, the absolute risk reduction (ARR), and the number needed to treat (NNT).ResultsFinancial review yielded an average institutional cost of treating a postoperative infection to be $13,282.85. This number was inclusive of all procedures during an inpatient stay. The added cost of the antibiotic coated implant to the hospital is $743.42. Utilizing the break-even formula with these costs and a 30% initial infection rate, antibiotic coated IMN was economically viable if it decreased infection rate by 0.056% (NNT = 1,785.714).ConclusionThis break-even analysis model suggests the initial use of an antibiotic coated IMN in the setting of GAⅢ open tibia fractures is cost-effective.     

Proximal avulsion of five ligaments and revised diagonal principle in tibial plateau fractures

PurposeThe aim of the study was to analyze the incidence of proximal avulsion of the five main ligaments and to revise the diagonal tension/compression concept in tibial plateau fractures.MethodsComputed tomographic images of 1263 cases of tibial plateau fractures were retrospectively analyzed by the OTA/AO classification and four-column nine-segment classification. The correlation between proximal avulsion of five ligaments and the injury mechanism was analyzed.ResultsIn total, 1263 tibial plateau fractures in 1253 patients were included. A total of 92 cases (7.3%) associated with proximal avulsions were identified among the 1263 tibial plateau fracture cases obtained from our institution's database. The 92 avulsions occurred in 82 patients, among whom 10 patients had two different avulsions in a single knee. The incidence of proximal avulsion fracture of the medial and lateral collateral ligament was 3.6% (45/1263) and 2.1% (26/1263), respectively. The incidence of avulsion of the anterior cruciate ligament and avulsion of the posterior cruciate ligament was much lower at 0.2% (2/1263) and 0.1% (1/1263), respectively. Proximal avulsion of the patellar ligament occurred in 18 cases (incidence rate = 1.4%). Several combinations of injuries, composed of distal tibial plateau fractures and proximal avulsion of ligaments, were identified.ConclusionsAmong the patients with tibial plateau fracture, the incidence of proximal avulsion of the five ligaments was 7.3% (92/1263). The four-column and nine-segment classification is an exhaustive method for recording injuries in these ligaments. The revised diagonal injury concept is useful for understanding the injury mechanism and choosing the appropriate surgical strategy.     

江苏省2006-2015年卵巢癌变化趋势及现状分析

目的 分析2015年江苏省卵巢癌发病和死亡现状及2006-2015年卵巢癌发病和死亡变化趋势,为江苏省卵巢癌防治提供依据。方法 利用2018年江苏省CDC收集的35个登记处2015年肿瘤登记资料,从中抽取卵巢癌数据,计算分城乡、年龄组发病（死亡）率、中国人口标化率（中标率）、世界人口标化率（世标率）、累积发病（死亡）率（0～74岁）、截缩发病（死亡）率（35～64岁）等指标,结合2015年江苏省户籍人口资料,估算全省卵巢癌发病（死亡）数。汇总2006-2015年全省肿瘤登记资料,利用Joinpoint 4.7.0.0软件分析卵巢癌发病（死亡）粗率、中标率、世标率的年度变化百分比（APC）。结果 2015年江苏省估计卵巢癌新发病例2 229例,约占女性全部恶性肿瘤发病的2.23%,位居女性恶性肿瘤发病顺位第12位;估计卵巢癌死亡1 239例,占女性全部恶性肿瘤的2.18%,位居女性恶性肿瘤死亡顺位第13位。江苏省女性卵巢癌发病率为5.91/10万,中标率为4.01/10万,世标率为3.81/10万,累积发病率（0～74岁）为0.42%。卵巢癌死亡率为3.29/10万,中标率为1.99/10万,世标率为1.96/10万,累积死亡率（0～74岁）为0.24%。2006-2015年江苏省卵巢癌发病粗率APC为4.66%（95% CI：2.11%～7.29%）,死亡粗率APC为7.45%（95% CI：5.46%～9.47%）,均P<0.05;卵巢癌发病中标率APC为2.30%（95% CI：-0.32%～4.99%）,发病世标率APC为2.41%（95% CI：-0.29%～5.20%）,均P>0.05;死亡中标率APC为4.43%（95% CI：2.54%～6.36%）,死亡世标率APC为4.55%（95% CI：2.58%～6.57%）,均P<0.05。结论 江苏省卵巢癌发病率、死亡率处于较低水平,城市高于农村,卵巢癌发病粗率、死亡粗率均呈上升趋势,经标化后发病趋势尚平稳,但死亡趋势上升明显。     

X线、CT、MRI及ECT评价支气管肺癌骨转移的临床价值

目的分析X线、CT、MRI及ECT评价支气管肺癌骨转移的临床价值。方法经医院伦理学会批准,随机选取我院2017年7月至2020年5月首次病理确诊的支气管肺癌120例。分别接受CT、MRI、ECT及X线诊断,分析CT、MRI、ECT及X线诊断结果 ,比较其阳性率。结果骨转移阳性率57.14%,CT阳性率57.14%,MRI阳性率为81.63%,ECT扫描阳性率为87.78%。CT、MRI、ECT及X线评价支气管肺癌骨转移阳性率差异比较有统计学意义(P<0.05),阳性率由高到低依次是ECT、MRI、CT、X线。结论支气管肺癌骨转移发生率较高,其中ECT较CT、MRI、X线对诊断支气管肺癌骨转移的早期诊断与治疗具有更为重要的意义。     

川黄1号方对慢性肾脏病3期患者尿IL-18及Kim-1的影响

目的:观察川黄1号方对慢性肾脏病(chronic kidney disease,CKD)3期患者尿液中急性肾损伤标志物白介素-18(IL-18)及肾损伤分子-1(Kim-1)的影响。方法:纳入66例CKD 3期患者,随机分为川黄1号方组(治疗组)及氯沙坦片组(对照组),每组各33例;同时随机纳入20例健康志愿者作为对照。两组患者除给予基础治疗外,治疗组予川黄1号方汤剂口服,对照组予氯沙坦片口服,治疗周期均为24周。比较两组患者治疗前后的血清肌酐(Scr)、尿素氮(BUN)、估算肾小球滤过率(e GFR,MDRD公式计算)、尿酸(UA)、尿IL-18、尿Kim-1、24 h尿蛋白定量(24 h U-pro)水平的变化,同时对比健康志愿者与CKD 3期患者尿IL-18、尿Kim-1的水平。结果:1与健康志愿者比较,CKD患者的尿IL-18、Kim-1水平均显著升高(P0.01)。2治疗后,治疗组患者的e GFR明显升高(P0.05),Scr、BUN水平明显降低(P0.05,P0.01),对照组患者的UA水平明显降低(P0.05);且治疗组患者的e GFR、UA水平高于对照组(P0.05),Scr、BUN水平低于对照组(P0.05,P0.01)。3治疗后,两组患者的24 h U-pro、尿IL-18、尿Kim-1水平较治疗前均明显降低(P0.05,P0.01),且对照组患者的24 h U-pro水平低于治疗组(P0.05),治疗组患者的尿IL-18水平低于对照组(P0.05)。结论:1急性肾损伤标志物尿IL-18、Kim-1可能有助于CKD肾损伤的早期发现及疗效判定;2川黄1号方能有效保护3期CKD患者的肾功能,具有较好的临床推广应用前景。     

脑卒中急性期心脏损害与临床治疗探讨

目的: 探讨脑卒中急性期心脏损害与临床治疗的关系。方法: 对82 例脑卒中患者入院时心电图改变与治疗后1～6 周内心电图变化作定期对比观察。结果: 脑卒中急性期心脏损害心电图呈现多种异常改变, 其中心律失常发生率为最高占67.1% , 其次心肌供血不足占32.9% , 但经过4～6 周积极治疗后好转率达84.1% 。结论:本资料研究表明, 脑卒中继发心脏损害随脑部症状好转而逐渐恢复, 原因在于积极有效地控制脑水肿是关键。稳定血压、维持水电平衡、改善血液流变学等, 对减轻心脏损害亦有积极的治疗意义     

启东市乙肝干预研究随访人群高血压发生率及与体重指数的关联研究

目的 了解启东市乙肝干预研究队列随访人群体重指数、血压水平的分布特征,探讨两者间的关联,为慢性病预防研究提供基础资料。方法 采用横断面调查方法,在2013年1~10月对启东市乙肝干预研究队列研究对象分层随机抽样,进行问卷调查（社会人口学特征、吸烟饮酒）和体格检查（测量身高、体重、血压）,收集健康体检数据,分析研究对象的性别、体重指数及烟酒嗜好与血压间的关联。结果 本次调查抽样人群8269人,超重率和肥胖率分别为17.90%和5.74%,高血压发生率为14.60%。男性高血压发生率高于女性,差异有统计学意义（P<0.05）。男女性高血压发生率随体重指数的增加而上升,趋势检验差异均有统计学意义（P均<0.05）。吸烟者与饮酒者高血压患病率分别高于不吸烟者和不饮酒者,差异有统计学意义（P<0.05）。结论 结合调查结果,应加强对启东市乙肝干预研究队列青年群体健康宣传教育,倡导健康生活习惯,积极控制超重与肥胖,减少高血压发病风险。     

Id4 promotes cell proliferation in hepatocellular carcinoma

Background: Hepatocellular carcinoma (HCC) is a common malignant tumor in the world, especially in China. As a member of the inhibitor of differentiation (Id) family, Id4 has been reported to function in many cancer types, but relatively little is known about its role in HCC. The purpose of this study was to investigate the potential relationship between Id4 and HCC development and the underlying mechanism involving the function of Id4 in HCC. Methods: We used quantitative real?time polymerase chain reaction and Western blotting to examine the RNA and protein expression of Id4. In addition, we used Cell Counting Kit?8 assay and colony formation assay to identify the function of Id4 in the regulation of cell proliferation in human HCC. Results: We found that the expression of Id4 protein was up?regulated in tumor tissues from HCC patients. Over?expression of Id4 promoted HCC cell proliferation, clonogenicity in vitro, and tumorigenicity in vivo. Id4 knockdown experiments showed that silencing Id4 blocked the proliferation and colony formation ability of HCC cells in vitro. Furthermore, overexpression of CCAAT/enhancer?binding protein β inhibited Id4 expression in HCC cells. Conclusion: Id4 may be developed as a potent therapeutic agent for the treatment of HCC, but more details about the underlying mechanisms of action are needed.     

小切口非超声乳化白内障摘出联合人工晶状体植入术的临床观察

目的:探讨小切口非超声乳化白内障摘出联合人工晶状体植入术的效果和特点.方法:对白内障行小切口非超声乳化摘出联合人工晶状体植入的100例( 100眼)进行回顾性分析.结果:术后1天矫正视力0.3以上55眼(55％),术后1周矫正视力0.3以上86眼(86％),术后1月矫正视力0.3以上90眼(90％),术中主要并发症为后...